The use of intraoperative neuroimaging tools and a navigation system in surgical treatment of primary and metastatic tumors of the spine

Minimally Invasive Surgery for Spinal Metastasis: A Review

OBJECTIVE

Minimally invasive surgery (MIS) techniques have advanced the treatment of metastatic diseases to the spine. The objective of this review is to describe clinical outcomes, benefits, and complications of these techniques.

METHODS

All relevant clinical studies describing the role of MIS, computer-assisted navigation (CAN), robot-assisted (RA) procedures, and laser interstitial thermal therapy (LITT) in the treatment of metastatic spine diseases were identified from PubMed, MEDLINE, and relevant article bibliographies.

RESULTS

For MIS articles, we filtered 1480 results and identified 26 studies. For CAN, we searched 464 articles to identify 18 articles for review. For RA, we searched 321 results to identify 7 studies for review. For LITT, we identified 21 articles for review.

CONCLUSIONS

MIS for the treatment of spine metastasis has significant potential benefits in reducing surgical site infections, hospital stay, and blood loss without compromising instrument accuracy or overall outcomes. Overall, MIS and its adjuncts have the potential to reduce the risks involved in the treatment of patients with metastatic disease to the spinal column without compromising the benefits of decompression and stabilization of the spine.

The Application of O-arm and Navigation System in Precise Localization of Spinal Cord lesions: a Case Series study

OBJECTIVE

To study on the clinical efficacy of precise localization of O-arm and navigation system in spinal cord lesions.

METHODS

From Augst 2015 to September 2019, 22 patients with spinal cord lesions were arranged in the group.The intraoperative cross-sectional images were acquired by O-arm image system, which were transferred to the Stealth navigation system, and fused with pre-opreative MRI images. The image fusion was completed by the Medtronic Synergy Cranial software. The fused images were used to locate spinal cord lesions, assisted by the navigation system. The navigation errors were evaluated by measuring the maximum distance between the end of the lesion in MRI and its real position.

RESULTS

The image fusion were completed in all patients, and we successfully completed the image-guided surgeries of the spinal cord lesions. The time of image processing was between 7 min and 19 min, and the mean value was 15.1 ± 2.2 min. The navigation error was between 0.9 mm and 5.3 mm, the mean value was 1.6 ± 0.9 mm.

CONCLUSION

The application of precise localization of O-arm and navigation system in spinal cord lesions is clinically reliable and feasible.

Imaging features of primary spinal osseous tumors and their value in clinical diagnosis

This study explored the method of imaging diagnosis of primary spinal osseous tumors and the application value of imaging in clinical diagnosis. Sixty-nine patients with primary spinal osseous tumors who received treatment in Nankai Hospital from July 2016 to June 2017 were selected. All of them received X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) examinations to analyze the imaging features of the three examination methods. Sensitivity (Sen), specificity (Spe), positive predictive value (PV⁺), negative predictive value (PV⁻) and accuracy (Acc) were compared. The consistency of the three examination methods in diagnosing primary spinal osseous tumors was analyzed. Sen, Acc and PV⁻ of the three examination methods in diagnosing spinal osseous tumors had obvious differences. MRI showed the highest Sen (P<0.05). MRI had relatively high consistency with CT scan in diagnosing primary spinal osseous tumors, and κ-value was 0.72. CT scan and X-ray had obvious difference in diagnosing primary spinal osseous tumors (P<0.05). The consistency between CT scan and X-ray in diagnosing primary spinal osseous tumors was relatively low, and κ-value was 0.47. MRI and X-ray had obvious difference in diagnosing primary spinal osseous tumors (P<0.05). The consistency between MRI and X-ray in diagnosing primary spinal osseous tumors was relatively low, and κ-value was 0.41. X-ray examination is easy to operate with high resolution. CT scan has obvious advantages in displaying lesions with complex structure, many of which locate in overlapping sites. MRI has more advantages and higher accuracy in judging the scope of the tumor. CT and MRI examinations have obviously higher efficacy than X-ray in diagnosing primary spinal osseous tumors. They are conducive in improving the accuracy of diagnosing primary spinal osseous tumors.